Cultures in psychiatric nosology: the CCMD-2-R & international classification of mental disorders

This essay reviews the Chinese Classification of Mental

Disorders, Second Edition, Revised (CCMD-2-R, 1995), by

assuming the theoretical stance that symptom recognition,

disease construction, and taxonomic strategy in psychiatry

reflect, and are constrained by, the cultural norms and values

as well as the political and economic organizations of the

society in which they are embedded.

The CCMD-2-R is an

ethnomedical classification grounded in both symptomatology

and etiology, in which Chinese psychiatrists seek to conform

with international classifications on the one hand, and to

sustain a nosology with Chinese cultural characteristics on

the other. Although broad similarities between the ICD-10 and

CCMD-2-R are evident, their blending is legitimately


Thus, the particular additions (e.g., travelling

psychosis, qigong induced mental disorders), deletions (e.g.,

somatoform disorders, pathological gambling, a number of

personality and sexual disorders), retentions (e.g., unipolar

mania, neurosis, hysteria, homosexuality), and variations

(e.g., depressive neurosis, neurasthenia) reveal not only the

changing notions of illness but also the shifting social

realities in contemporary China. The CCMD-2-R will be widely

used by Chinese psychiatrists and should standardize

diagnostic practice and facilitate research, but its impact

on everyday clinical work and psychiatric training remains to

be evaluated. For Western researchers, it is one avenue for

achieving an understanding of the Chinese social world, and

should usefully be contrasted with the ICD-10 and DSM-IV as

the move towards an international nosology continues.

Lee S

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